Early awareness of cerebrospinal fluid hypovolemia after craniotomy for microsurgical aneurysmal clipping
Early awareness of cerebrospinal fluid hypovolemia after craniotomy for microsurgical aneurysmal clipping
复制标题
显微动脉瘤夹闭开颅手术后早期意识到脑脊液低血容量
DOI：
10.1007/s00701-013-1755-4
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发表时间：
2013
影响因子：
2.4
通讯作者：
H. Baba
中科院分区：
文献类型：
--
作者：
I. Kawahara;K. Tsutsumi;Y. Matsunaga;H. Takahata;Tomonori Ono;K. Toda;H. Baba
研究背景轻度脑脊液低血症是一种常见的临床疾病，但严重的脑脊液低血症可导致小脑幕切开术后脑脊液低血症，是一种罕见的临床疾病。我们调查了蛛网膜下腔出血(SAH)显微外科动脉瘤夹闭术后脑脊液低血容量的情况。腰椎引流(LD)是在全身麻醉后或术后作为标准的围手术期方案插入的。结果11例(7.6%)患者术后0~8天按诊断标准诊断为脑脊液低血症。在所有患者中，通过夹闭LD和使用Trendelenburg体位，脑脊液低血症的体征或症状在24小时内得到改善。结论脑脊液低血症作为动脉瘤夹闭后急性临床恶化的原因，可能被低估，实际上可能被误诊为血管痉挛或脑肿胀。应充分考虑脑脊液低血症的病因，尤其要注意CT上有气脑、硬膜下积液并伴有脑下垂的患者。与脑室引流相比，这些患者在颅室和脊室之间出现压力梯度的风险更高，因此，LD术后脑组织下垂的风险更高。我们应该提高警惕，严格管理LD，以免产生高压力梯度。
BackgroundMild cerebrospinal fluid (CSF) hypovolemia is a well-known clinical entity, but critical CSF hypovolemia that can cause transtentorial herniation is an unusual and rare clinical entity that occurs after craniotomy. We investigated CSF hypovolemia after microsurgical aneurysmal clipping for subarachnoid hemorrhage (SAH).MethodThis study included 144 consecutive patients with SAH. Lumbar drainage (LD) was inserted after general anesthesia or postoperatively as a standard perioperative protocol. CSF hypovolemia diagnosis was based on three criteria.ResultsEleven patients (7.6 %) were diagnosed with CSF hypovolemia according to diagnostic criteria in a postoperative range of 0–8 days. In all patients, signs or symptoms of CSF hypovolemia improved within 24 hours by clamping LD and using the Trendelenburg position.ConclusionsAs a cause of acute clinical deterioration after aneurysmal clipping, CSF hypovolemia is likely under-recognized, and may actually be misdiagnosed as vasospasm or brain swelling. We should always take the etiology of CSF hypovolemia into consideration, and especially pay attention in patients with pneumocephalus and subdural fluid collection alongside brain sag on computed tomography. These patients are at higher risk developing of pressure gradients between their cranial and spinal compartments, and therefore, brain sagging after LD, than after ventricular drainage. We should be vigilant to strictly manage LD so as not to produce high pressure gradients.